Welch Allyn Means ECG Physicians Manual for CP Series Electrocardiographs - User Manual - Manual (Page 29)

MEANS Physicians Manual
Welch Allyn
29
2.21 Interaction of statements
When the classification process leads to coexisting diagnostic statements, a weighing
procedure may come into play to change the certainty qualifier of one or more of the
statements. These changes are described below. The following hierarchy is adopted:
“consider”, “possible”, “probable”, “definite” (the default value). The terms “pronounced” and
“very pronounced” imply “definite” certainty but add a measure of severity.
LBBB and LVH:
When LBBB is at least “probable”, any concomitant LVH statement is suppressed if QRS
duration is

140 ms. For QRS durations between 130 and 140 ms, the certainty of LBBB is
lowered to “possible” and LVH is not suppressed.
If LBBB is “possible” and LVH is at least “probable”, the LBBB qualifier is lowered to
“consider”.
LBBB and IVCD:
If QRS duration
 180 ms, the LBBB qualifier is increased by one point, e.g., “possible”
becomes “probable”. Any IVCD statement is suppressed in the presence of LBBB.
(I)RBBB and infarct:
In the presence of a septal or anterior infarct that is at least “probable”, the statement
“consider also periinfarct block” is added to the RBBB statement.
The qualifier of an inferior infarct is lowered one point in the presence of RBBB.
Incomplete RBBB is suppressed if RVH or infarct is at least “probable”.
Any IVCD statement is suppressed in the presence of (I)RBBB.
LVH and infarct:
If the LVH qualifier is higher than the highest infarct qualifier, all infarct qualifiers are lowered
one point. If the reverse is true, the LVH qualifier is lowered one point.
Lateral infarct and high-lateral infarct:
The infarct with lowest qualifier is suppressed, provided that no inferior infarct has been
found.
ST elevation and LBBB, LVH, or ST depression:
An ST elevation statement is suppressed if the presence of LBBB is at least “probable” or if
an LVH statement is made, unless an infarct statement is present with a stronger qualifier
than LVH.